Pulmonary rehabilitation in minimal versus high resource settings in COPD: a non-inferiority and economic evaluation

Comparison of results and associated costs of pulmonary rehabilitation (PR) conducted with minimal resources (MR) versus specialised centres (SC) for people with chronic obstructive pulmonary disease (COPD) remains uncertain.

We assessed the effects, non-inferiority and associated costs in Portugal of PR with MR compared to PR in SC for COPD.

PR was conducted with MR and in SC. The functional assessment of chronic illness therapy-fatigue scale-FACIT-FS, hospital anxiety and depression scale-HADS, COPD assessment test-CAT, St. George's Respiratory Questionnaire-SGRQ, quadriceps maximum voluntary contraction-QMVC, Brief-Balance Evaluation Systems Test-Brief-BESTest, 6-min walk test-6MWT and 1-min sit-to-stand-test-1minSTS were assessed pre-post PR. Effects were explored with robust/linear mixed effects model. Costs of PR implementation and intervention were estimated.

158 people with COPD (69±8years; 79.7 % male; FEV₁ 49.0[40.0; 65.8]%predicted) participated, 72 in MR and 86 in SC. No Time∗Group interaction was observed, except for the SGRQ. Improvements were significant for all measures in both settings. Non-inferiority was demonstrated for FACIT-FS, HADS-D, QMVC, Brief-BESTest and 1minSTS but inconclusive for HADS-A, CAT, SGRQ and 6MWT. PR implementation costs were 8384€ with MR vs. 33,123€ in SC. Intervention costs were 5168€ and 9803€/program including non-emergency medical transportation (646€ vs. 1225€/person) in MR and SC, respectively.

PR with MR has multiple benefits for people with COPD at a lower cost than in SC. However, its non-inferiority compared to SC remains inconclusive for core outcomes. PR with MR could be an effective alternative to increase access to this essential intervention when SC are unavailable.